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Assessments for Racial Trauma

Despite arguments for and against conceptualizing racial trauma as PTSD, and thus, a mental illness, many researchers agree that increasing the availability of valid, appropriate assessments for racial trauma is essential. Although the consensus is that more work should be done in this area (due to limitations in assessing racial trauma using traditional measures for PTSD) listed below are some assessments for racial trauma. Please note that these measures are newer and have largely only been validated and tested by their authors.

• The Race-Based Traumatic Stress Symptom Scale (RBTSSS) is a 52-item self-report measure that prompts individuals to recall and rate various emotional impacts of the three most significant race-related traumatic events they experienced throughout their lifetimes. The RBTSSS was created to measure a distinct construct for racial trauma that is markedly separate from PTSD, with the hopes that this construct would more accurately represent the uniquely deleterious experience of racism. As such, the RBTSSS has seven subscales (as compared to the four main symptom types in PTSD diagnosis): anger, avoidance, depression, intrusions, hypervigilance, low self-esteem, and physical symptoms. There is also an abbreviated form of the RBTSSS: the Race-Based Traumatic Stress Symptom Scale - Short Form (RBTSSS-SF).
• The Racial Trauma Scale (RTS) is a self-report measure which prompts individuals to rate their various responses (cognitions, behaviors, other symptoms; 30 responses in total) to vicarious or overt racism. Although the RTS is a newer scale, and thus less widely known and used, it shows potential for usefulness in assessing distress as a consequence of race-based traumatic experiences. A short-form, 9-item version of the RTS also exists.
• The Trauma Symptoms of Discrimination Scale (TSDS) is another self-report measure (21 items) that attempts to capture the cumulative effect of experiencing multiple racist and race-related events over one's lifetime. The TSDS specifically focuses on assessing trauma symptoms with stress and anxiety features by prompting individuals to rate their distress after each singular experience of discrimination that has occurred throughout their lives. Research suggests that the TSDS has four sub-constructs: uncontrollable hyperarousal, feelings of alienation, worries about future negative events, and perception of others as dangerous.
• The University of Connecticut (UConn) Racial/Ethnic Stress and Trauma Survey (UnRESTS) is a clinician- or evaluator- administered measure that includes a semi-structured interview to assess for racial trauma and race-related traumatic experiences. The UnRESTS bases its structure and framework on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Cultural Formulation Interview and has different instruction sets for those in evaluator roles versus clinician roles. The UnRESTS sections include race and ethnic identity development, microaggressions, overt racism, covert racism, vicarious racism, and a symptom checklist based on PTSD symptomology. There are English and Spanish version of the UnRESTS.
• Although not explicitly created to assess for racial trauma, the General Ethnic Discrimination Scale (GEDS) is an 18-item self-report measure that relatedly and often is used to gauge individuals' experiences of racial and ethnic discrimination, as well as the impact of those events, both over their lifespan and within the last year. The GEDS is intended for use with diverse individuals with various racial and ethnic identities, rather than for one ethnic or racial group in particular.

PTSD and trauma measures that may moderately capture experiences of race-based trauma include:

• Trauma and Attachment Belief Scale (TABS) - Self-Safety Subscale
• Life-Stressors Checklist-Revised
• Mississippi Scale for Combat-Related Posttraumatic Stress Disorder (M-PTSD)
• Mississippi Scale for Combat-Related Posttraumatic Stress Disorder - Civilian Version (M-PTSD-C)
• Peritraumatic Dissociative Experiences Questionnaire (PDEQ)

Measures that may only capture the cumulative effect of racism and overt racist experiences (rather than specific events and vicarious racial trauma) include:

• The Schedule of Racist Events (SRE)
• Spencer Discrimination Scale
• Race-Related Events Scale (RES)
• Schedule of Racist Events
• Work Environment Inventory (WEI)
• Race-Related Stress Scale
• Impact of Race-Related Events (IRE)
• Perceived Ethnic Discrimination Questionnaire (PEDQ)
• Acculturative Stress Scale for International Students (ASSIS)
• Race-Related Events Scale (RRES)
• Perceived Racial/Ethnic Discrimination Stress Scale
• Experiences of Discrimination Scale
• Everyday Racial Discrimination
• The Oppression Questionnaire (OQ)
• The Brief Perceived Racism in the Workplace Scale (BPR)

Resilience and Healing from Racial Trauma

When considering a more general approach to treatment (rather than tailoring treatment to a specific racial group), there are a few methods that can promote healing from racial trauma. Developing a strong sense of one’s cultural identity, engaging with social support, and making plain the personal and community-level consequences of racism all seemingly foster healing from racial trauma.

Researchers have emphasized the importance of framing resilience and healing not only from an individualistic—but also a community and societal perspective. Viewing resilience collectively not only better aligns with some communities who suffer more often from racial trauma—but also enables a lens in which healing from trauma can be contextualized as work that must be done on a systemic level. In this vein, some advocate for the use of a liberation psychology approach to bolster resilience and healing from racial trauma. Using a liberatory approach to treating racial trauma means acknowledging and deconstructing the sociopolitical context to better understand an individual's experience of racism and oppression. By acknowledging the systemic oppression that an individual has faced while also centering their experiences and perspectives as a person of color, clinicians can better engage in client-centered work that allows the individual to shape their own healing journey. Self-determination can be meaningful to clients of color when one considers the historical and pervasive impacts of colonialism and control on their communities. Additionally, liberation psychology approaches instruct that the onus should not solely be on the client to do the work; therapists should also continue to learn and seek information from communities affected by racial trauma, ultimately serving as advocates for their clients and engaging in social justice activism.

Various approaches to promote healing from racial trauma were created for racial groups considered particularly vulnerable to such traumatic experiences. In particular, frameworks were created for Latinx immigrant and Black/Africana communities. Chavez and colleagues created a healing framework for Latinx immigrants called the HEART framework. The HEART framework consists of four phases: (1) developing a “sanctuary” in which Latinx immigrants feel validated and their immediate concerns or problems are addressed (2) implementing treatments supported by research while also contextualizing Latinx immigrants’ experiences of racial trauma (3) instilling racial pride and increase Latinx immigrants’ sense of connection to Latinx culture (4) encouraging resistance of oppression through engagements with social justice. Chioneso and colleagues created a healing framework for Africana communities called C-HeARTS. C-HeARTS centers justice to promote personal, interpersonal, and systemic well-being in Africana communities. The framework also encourages culturally congruent means of making sense of and healing from racial trauma; such means include storytelling and resisting sociopolitical oppression. Anderson and Stevenson (2019) created the racial encounter coping appraisal and socialization theory (RECAST) to center the impact of the racial identity socialization process and coping on Black individuals when treating them for vicarious and overt racial trauma. Additionally, using an anticolonial lens for treatment may bolster resilience and healing in Indigenous populations.

Finally, several researchers have started to adapt traditional evidence-based approaches to therapy to treat racial trauma in youth and adults of color. Cognitive behavioral therapy (CBT), widely used to treat mental illnesses (e.g., depression, anxiety, PTSD), does not traditionally incorporate skills to cope with racial trauma. However, clinicians and researchers have begun to adapt trauma-focused CBT (TF-CBT) to treat racial trauma and discrimination in African American youth by applying the RECAST model. Additionally, researchers argue that another effective treatment for PTSD, prolonged exposure (PE), should incorporate themes related to racial trauma when working with people of color, and specifically, Black clients. They suggest that clinicians center and directly ask about race-related themes and experiences throughout treatment. And while researchers are still exploring the evidence basis and efficacy of narrative therapy, the above framework (C-HeARTS) incorporates aspects of narrative therapy (e.g., storytelling) and emphasizes the importance of using the individual's testimony, or testimonio, as contextualized by racial and historical trauma to process and move negative thoughts towards becoming more positive.

Edit note - edited previous content in "Resilience and Healing from Racial Trauma" for clarity and conciseness, added sections on liberation psychology approaches and adaptations of EBPs for treating racial trauma.